- Click here for explanation of classification scheme.

The following are the 2002 recommendations (position statement) of the American Diabetes Association on tests used most widely in monitoring the glycemic status of individuals with diabetes.

None specifically mentioned.

None specifically mentioned.

Recruitment

Included articles not specified, only 3 references cited.  This position statement was based on the technical review:  Tests of glycemia in diabetes, Diabetes Care, 1995.

Design

Consensus Report.

Blinding Used (if applicable):

Not applicable.

Intervention (if applicable):

Not applicable.

Statistical Analysis:

Statistical analysis not completed.

Timing of Measurements

Not applicable.

Dependent Variables

Not applicable.

Independent Variables

Not applicable.

Control Variables

 

Initial N:  Only 3 articles references - the Technical Report and 2 Consensus Statements.

Attrition (Final N):  Not applicable

Age:  Not mentioned

Ethnicity:  Not mentioned

Other relevant demographics:

Anthropometrics

Location:  Not mentioned   

 

BLOOD GLUCOSE TESTING BY PATIENTS 

Recommendations:

1.  Based principally on DCCT results, most individuals with diabetes should attempt to achieve and maintain blood glucose as close to normal as safely possible.

• All treatment programs for type 1 diabetes should include daily self-monitoring of blood glucose (SMBG) because most patients with type 1 diabetes can achieve this goal only with SMBG.
• SMBG is especially important for patients treated with insulin or sulfonylureas to monitor for and prevent asymptomatic hypoglycemia.
• Type 1 diabetes: 3+ times/day is recommended for most people.
• Type 2 diabetes: test as necessary to facilitate reaching glucose goals.
• Type 2 diabetes controlled with diet: role of SMBG is unknown.

 2.  Efforts should be made to increase appropriate use of SMBG.  Barriers to use of SMBG are:

• Cost of testing (SMBG supplies should be covered by health insurance)
• Patients and providers have inadequate understanding of SMBG benefits and proper SMBG technique 
• Patient discomfort (physical and psychological)
• Inconvenience

3.  Providers need to evaluate accuracy of each patient’s monitoring technique, initially and at periodic intervals and use calibration and control methods to ensure accuracy. Patients should know if their home monitor is calibrated to whole blood or plasma blood.

4.  Patients need the skills to interpret the results of blood glucose monitoring in adjusting MNT, exercise and/or diabetes medications to achieve glycemic goals.

Blood glucose testing by health care providers for routine outpatient management of diabetes 

Recommendations:

1. With the availability of SMBG and glycated protein testing, routine laboratory blood glucose testing should no longer be used to assess glycemic control, but can supplement other test results.
2. Comparisons between patient SMBG and simultaneous laboratory testing is recommended to assess the accuracy of patient testing as well as the accuracy of the glucose meter.
3. Continuous 24-hour glucose monitoring may be used to determine glucose trends, however its role in improving diabetes outcomes remains to be established.

Urine glucose testing/ Urine ketone testing/ Blood ketone testing 

SMBG is preferred because of limitations with urine glucose testing.

Urine ketone testing is an important part of monitoring for patients with type 1 diabetes, pregnancy with existing diabetes, and gestational diabetes.

Urine ketones may indicate impending or even established ketoacidosis.

All patients should test urine for ketones during acute illness or stress or when blood glucose levels are consistently elevated (e.g. >300 mg/dL), during pregnancy, or when any symptoms of ketoacidosis (nausea, vomiting, or abdominal pain) are present. Urine ketones are found in normal individuals during fasting and in up to 30% of first morning urine specimens of pregnant women.

Blood ketones (ß-hydroxybutyrate) are more accurate for diagnosing and monitoring treatment of ketoacidosis.

Home tests for blood ketones are available.

Glycated protein testing 

Glycated hemoglobin (GHb) testing (HbA1c, or A1C)

GHb most accurately reflects the previous previous 2-3 months of glycemic control.

A1C predicts the risk for the development of many of the chronic complications in diabetes. Optimal use of A1C for this purpose requires standardization of the assays.  The National Glycohemoglobin Standardization Program began in mid-1996.

GHb testing should be performed routinely in all patients with diabetes, initially to document glycemic control and then for part of continuing care.

Testing should be done quarterly for those who are making treatment changes and twice a year for those in good glycemic control.

The American Diabetes Association recommends that the goal of treatment should be <7% and that the physicians reevaluate the treatment plan when values are consistently >8%.

Glycated serum protein (GSP)

Measurements of total glycated serum protein and glycated serum albumin correlate well with one another and with GHb.

The use of GSP can be recommended to document relatively short-term changes in glycemic status, e.g. in pregnancy or after major changes in therapy.

GSP results have not been show to be related to the risk of development or progression of chronic complications of diabetes.

Fructosamine is one of the most widely used GSP.

Fructosamine provides an index of glycemic status over the preceding 1-2 wks.

More studies are needed to validate the use of GSP for evaluating and treating individuals with diabetes.

This paper's recommendations are outlined under the headings "Blood Glucose Testing By Patients"  (1-4) and "Blood Glucose Testing By Health Care Providers For Routine Outpatient Management Of Diabetes" (1-3).  Additional conclusion statements are stated throughout the paper.

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Current studies regarding glucose testing in diabetes should be reviewed.  This review paper attempted to answer many questions.  Each of the questions could be looked at individually (ie. accuracy of SMBG, frequency of testing, interpretation of SMBG, etc.)